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Biomedical subjects

W H Ramsey

Publications and source records attributed to W H Ramsey.

18 recordsLinked to original sources
PubMed2001

Utility of retroflexion in lower gastrointestinal endoscopy.

Although recommended, retroflexion to evaluate the rectal vault is not always practiced in endoscopy. A prospective study of 600 consecutive patients undergoing flexible sigmoidoscopy or colonoscopy was done to evaluate whether retroflexion increased the diagnostic yield compared with straight view examination of the distal rectum and whether the findings altered subsequent patient management. In this study, 30 patients were found to have distinct lesions in the anorectum. More than 50% of lesions in the rectal vault were identified only by retroflexion. Adenomatous polyps were seen in nine patients, of which six were identified only by retroflex view. Fifty percent of patients with adenomatous polyps in the rectal vault identified only by retroflexion during screening sigmoidoscopy were found to have right sided adenomas on colonoscopy. The retroflex view produced significant additional information, compared with standard forward view of the rectum, and altered the patient management plan. The procedure was easily performed without complications and was tolerated well by patients. Unless contraindicated, rectal retroflexion should be universally practiced and emphasized in training as more nonphysicians become involved in performing sigmoidoscopy.

Endoscopy, Gastrointestinal↗
PubMed2000

Thrombotic thrombocytopenic purpura in acute pancreatitis.

Thrombotic thrombocytopenic purpura (TTP) is a rare syndrome of unknown cause with an estimated incidence of one case per million. The disease is characterized by a pentad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, neurologic changes, renal dysfunction, and fever. It causes thrombosis in the microvasculature of several organs, producing diverse manifestations. Acute pancreatitis (AP) is a well-described consequence of TTP. We report a patient who developed TTP after presenting with AP, suggesting pancreatitis to be the cause, rather than a consequence, of TTP.

Acute Disease↗
PubMed2000

Recurrent upper gastrointestinal bleeding due to the Dieulafoy's lesion.

Dieulafoy's lesion of the gastrointestinal tract, an abnormally dilated artery that penetrates through the mucosa, has been diagnosed more frequently in recent years. Bleeding occurs when the vessel ruptures. Despite widespread awareness of this entity, it remains a diagnostic challenge for gastroenterologists because of its small size and hidden location. Several different diagnostic methods and treatments have been introduced throughout the years. Endoscopy plays a major role in diagnosis and therapy. In this case report, the patient was successfully treated endoscopically using epinephrine injection and heater probe thermoco-agulation. The characteristics of the Dieulafoy's lesion, its current diagnosis, treatment, and complications are discussed.

Aged↗
PubMed1999

Massive and widely distributed splenosis.

A 45-year-old man, seropositive for hepatitis C, was examined because his liver was palpable well below the costal margin. A CT examination revealed multiple nodules within the liver and also several sites of ectopic tissue. The patient had a splenectomy 25 years before. A radiocolloid study showed uptake, consistent with splenosis, in the thorax, abdomen, pelvis, and possibly the left arm. The magnitude of the ectopic tissue, and its multiple locations, indicated the ability of splenic cells to grow in a variety of body sites.

Humans↗
PubMed1994

Monitoring patients taking methotrexate for hepatotoxicity. Does the standard of care match published guidelines?

BACKGROUND: Controversy persists regarding the validity of published guidelines for the monitoring of methotrexate-induced hepatotoxicity. OBJECTIVE: The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepatotoxicity and to compare this standard of care with guidelines in the medical literature. METHODS: Gastroenterologists in Connecticut and Massachusetts were surveyed by a mail-in questionnaire that inquired about their protocol for the monitoring of hepatotoxicity in patients taking methotrexate. RESULTS: Gastroenterologists in Connecticut and Massachusetts generally follow the guidelines in the medical literature. Variation in recommendations from the rheumatologic and the dermatologic literature is reflected in the practice habits of gastroenterologists whose patients are restricted to one particular population. CONCLUSION: Long-term follow-up studies should be continued to obtain further data from which to make future recommendations, especially with regard to the effects of large cumulative doses of methotrexate.

Alanine Transaminase↗
PubMed1988

Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.

We present a prospective, unrandomized, uncontrolled series of 1272 patients in whom endoscopic sphincterotomy (ES) was performed, and who had not previously undergone cholecystectomy. These patients were culled from our combined experience of a total of 4177 patients in whom ES was performed over the last 13 yr. Of the group reported here, 1208 patients had demonstrable gallbladder stones, and 64 had acalculous gallbladders. The group included 896 females and 396 males whose mean age was 73.3 yr and who ranged from 17 to 101 yr old. Cholangitis was present in 317 patients (25%), and gallstone pancreatitis in 134 (10.5%) patients. After sphincterotomy, 109 patients (8.6%) developed cholecystitis; 23 developed this within 48 h, and 86 developed this within 10 days of the procedure. Emergency surgery was performed on 25 of these patients, and 84 responded to medical therapy alone. Two deaths occurred within 30 days of sphincterotomy (0.15%), in both cases following emergency surgery in elderly patients. One hundred-eight patients underwent elective cholecystectomy within 3 yr of their sphincterotomy because of recurrent symptoms referrable to the biliary tract. In a subset of 337 patients in whom long-term followup was possible, two patients died of complications related to recurrent cholecystitis, both at approximately 2 yr after sphincterotomy. Although followup was less than optimal in this large series of patients, the data presented here suggest that an intact gallbladder is not a contraindication to ES in the management of common bile duct stones, and that the morbidity and mortality of ES compare favorably over the long and short term with surgical management.

Adolescent↗
PubMed1986

Endoscopic biliary stent placement for bile duct stricture after hepatic artery infusion of 5-FUDR.

Three patients with metastatic colorectal adenocarcinoma developed bile duct strictures after treatment of liver metastases by hepatic artery infusion of 5-fluorodeoxyuridine (5-FUDR). All underwent decompression and drainage via endoscopically placed biliary stents, a treatment approach not previously reported in this setting. One patient with recurrent hepatic metastases did not benefit, but two patients with bile duct strictures and tumor regression profited from stent placement and died of nonbiliary tumor-related complications. Stent placement may be helpful in treating patients with persistent and unremitting cholestasis and bile duct strictures in whom tumor regression has followed regional chemotherapy.

Adenocarcinoma↗
PubMed1979

Gastrointestinal angiodysplasia associated with aortic valve disease: part of a spectrum of angiodysplasia of the gut.

Twelve patients with angiodysplasia of the gastrointestinal tract were seen at The Mary Imogene Bassett Hospital are presented. Six share the features of gastric or duodenal angiodysplasia, advanced age, and aortic valve disease. Of these 6 patients, 4 who bled repeatedly were treated with endoscopic coagulation of areas of gastric and duodenal angiodysplasia. Six patients with other types of gastrointestinal angiodysplasia are presented for comparison. Two had gastric angiodysplasia and no aortic valve disease, 2 had hereditary hemorrhagic telangiectasia, 1 had received irradiation, and 1 could not be classified. We suggest that angiodysplasia of the gastrointestinal tract can be regarded as a spectrum with a clearly inherited etiology on one extreme and an acquired etiology on the other. A subset of these patients may be associated with aortic valve disease. Angiodysplasia of the upper gastrointestinal tract may account for a significant fraction of previously unexplained bleeding. It is hoped that this paper will aid in their more frequent recognition.

Aged↗
PubMedDate not supplied

Treatment of malignant biliary obstruction by endoscopic implantation of iridium 192 using a new double lumen endoprosthesis.

Iridium 192 seeds contained in a ribbon were preloaded into a new double lumen 11 Fr endoprosthesis which was then inserted into malignant strictures of the bile duct and ampulla and left in place for 48 hours until 5000 rads were delivered to the tumor. The procedure was carried out in 14 patients (7 women, 7 men; mean age, 63.2 years; range, 46 to 86 years). Six patients were treated for cholangiocarcinomas, four with pancreatic carcinomas, and four with ampullary carcinomas. No complications occurred. The mean survival of the group was 7 months (range, 3 days to 27 months). This new technique provides both intraluminal brachytherapy and biliary drainage and is inserted intraduodenally across the papilla of Vater avoiding puncture of the liver and external hardware required by the percutaneous technique and hardware necessitated with a nasobiliary tube. Following removal of the iridium prosthesis, a large caliber endoprosthesis is inserted for continued decompression. Because of proven efficacy of endoprostheses, this new technique should be considered when intraluminal irradiation is indicated.

Adenoma, Bile Duct↗
PubMedDate not supplied

Hepatocellular carcinoma: update on diagnosis and treatment.

In this review, the current approach to the screening, diagnostic evaluation, staging, and treatment for hepatocellular carcinoma (HCC) is outlined. The serum alpha-fetoprotein (AFP) level and abdominal ultrasonography (US) remain the cornerstones of screening protocols for HCC. Other serum marker proteins, such as abnormal serum prothrombin (PIVKA-II), when used in conjunction with AFP, can increase the yield for HCC. For diagnosis and staging of HCC, other imaging modalities employed include CT scan, infusion hepatic angiography, CT with arterial portography or iodized oil enhancement, MRI with contrast enhancement, intraoperative US, and US-guided fine-needle aspiration cytology and biopsy. Treatment options which have afforded some improvement in survival and tumor regression include surgical resection, orthotopic liver transplantation, percutaneous injection of ethanol, arterial chemoembolization, cryotherapy, and systemic or regional chemotherapy. Despite these advances, the diagnosis of HCC still portends a dismal prognosis.

Carcinoma, Hepatocellular↗